If you’re pregnant with twins, you are probably experiencing some of the most exciting (and maybe anxious) times of your life. You’ll need to get double of everything from cute baby clothes to car seats to toys. You will also need to pay more attention to how healthy you are during your pregnancy.

Twin pregnancies (and those with even more multiples) are known as high-risk, but this shouldn’t scare you. It simply means that you and your doctor will need to keep a more watchful eye on your health and that of your babies. Here are some things to be aware of during this time.

Types of twins

There are three main types of twins, though most people are only familiar with the terms “identical” and “fraternal.” Here is some basic information about these types of twins that can help you understand possible health risks for you and your little ones.

Mono-mono twins

Also known as monoamniotic-monochorionic twins, these monozygotic (identical) multiples develop in the same amniotic sac and share one placenta. About one percent of all identical twins are mono-mono. Like all identical twins, the egg-sperm combination will split to form two babies. The difference is when this split occurs. For mono-mono twins, the split happens about a week or so after conception.

There are risks involved with having mono-mono twins because they share a placenta and amniotic sac. These include TTTS (twin-to-twin transfusion syndrome), issues with the umbilical cords, abnormal amniotic fluid levels, low weight at birth, and prematurity.

Mono-di twins

Monoamniotic/dichorionic (also known as mono-di) twins, share a placenta but each has its own amniotic sac. Like mono-mono pairs, these twins are identical and share the same genes. Identical twins are at a higher risk for developing complications, although mono-di babies are overall at less of a risk because they do not share everything. Here are some, but not all, of the risks that you should be aware of.

• Prematurity
• Low birth weight
• Placental abruption, a condition in which one placenta pulls away from the uterine wall
• Placenta accreta, a condition in which a placenta is too deeply embedded within the uterine wall

Di-di twins

Both identical and fraternal twins can be di-di, or dichorionic-diamniotic, though all fraternal pairs are of this type. Di-di twins each have their own placentas and amniotic sacs, sharing only the womb to develop. This puts them at the least risk out of all the kinds of twins, but there are still some things to know if you are having them.

Low birth weight and prematurity are risks that all twins face. In this type of twin, placental issues like accreta, abruption, and previa can also occur. It is just as important to pay attention to what your obstetrician says if you are having lower-risk twins.

Risks of twin pregnancies to moms

Although no pregnancy is without risk, expectant moms who are having twins must be aware of specific conditions. Your obstetrician should tell you about all of the health risks involved when having multiples. Some of these issues can be more dangerous than others, but they can all affect your babies.

Hypertension: There is an increased risk for mothers with multifetal pregnancies to develop gestational hypertension (high blood pressure in pregnancy). If left untreated, this condition can result in premature birth or preeclampsia.

• Preeclampsia: This condition includes protein in the urine as well as hypertension. It may also present with other symptoms such as fast weight gain, severe headaches, pain in the upper ride side and upper-middle abdomen. If this is not treated, it can lead to eclampsia. This condition can range from mild to severe and can sometimes require immediate delivery or it can be watched closely to give babies more time in the womb. Timing of delivery depends on many factors associated with this common pregnancy complication.
• Eclampsia: This severe condition, also called toxemia, causes seizures in the mother. It can be life-threatening to babies and the mother. Anticonvulsant and blood pressure medicines can help with the symptoms and potentially give babies a little more time in the womb. Delivery is the only way to cure preeclampsia and eclampsia.

Gestational diabetes: This health issue happens when a pregnant mother gets diabetes during pregnancy when she did not have it before she was pregnant. As is common for those who are diabetic, it can be treated with lifestyle and dietary changes, but sometimes medication is necessary to protect the mother and fetus(es).

Hyperemesis gravidarum: Intense morning sickness is something that any expectant mom can experience. Hyperemesis gravidarum is a severe type of morning sickness that can result in fast weight loss that could harm mothers and babies. Occasionally mothers pregnant with more than one fetus may experience extra nausea and vomiting due to the extra hormones circulating in the blood.

Preterm delivery and Preterm Rupture of Membranes: Since the uterus is larger than normal with more than one fetus, there is an increased risk of both early delivery and/or rupture before term.

Other risks: There are many other risks that pregnant mothers should be aware of. Some experience gastrointestinal issues like constipation and this can be worse for multifetal pregnancies. Mothers of twins are at a higher risk of needing a cesarean section or having a premature birth.

Health risks for twins

Twins are at risk of many conditions before birth and even death, more so than other babies. Multifetal pregnancies have a higher rate of miscarriage for one (vanishing twin syndrome) or both babies. Here are some risks that your doctor will likely discuss with you:

Intrauterine growth discordance: This condition refers to one twin growing significantly slower than the other. It can also be a sign of TTTS (twin-to-twin transfusion syndrome).

TTTS (twin-to-twin transfusion syndrome): This dangerous health condition is characterized by one of the mono-mono or mono-di pair taking more than a healthy share of blood flow from the placenta. TTTS affects 10% of monochorionic (where identical twins share one placenta) pregnancies and can result in the death of one or both babies, especially if left untreated.

Prematurity: Premature birth happens after 20 weeks but before 37 weeks. The average twin mom gives birth at 35 weeks, which is an entire month less than singleton births. There are many conditions that can arise because of prematurity, including both short-term and long-term issues.

• Short-term: Low birth weight, although common in all multiples, is more common when they are born prematurely. Other issues include underdeveloped lungs, nervous system issues, heart conditions, brain bleeds, stomach or intestinal tract problems, and difficulty with breastfeeding.
• Long-term: Because of the advances in medical technology, a large majority of premature twins born at or after 23-24 weeks survive. They can, however, experience long-term health issues.
  • Chronic lung conditions like Bronchopulmonary dysplasia (BPD) can affect twins for months after birth.
  • Asthma and respiratory infections may be more common in older twins that experienced breathing issues as babies.
  • Developmental delays and learning disabilities may not be apparent, even for years.
  • Visual issues and hearing problems can also affect twins as they get older.

Having a healthy twin pregnancy

Staying healthy is the most important thing a mother can do in any pregnancy. This is especially true for mothers expecting twins (or more bundles of joy). Following the steps below can help you reduce the risks associated with having multiples. It is important to remember that your obstetrician and other qualified healthcare professionals are the only ones that can give you health advice.

1. Get prenatal care: You need to be doing this regularly. Your doctor will be equipped to help you handle every stage of your pregnancy and answer any questions you may have.
2. Listen to your doctor: You need to attend all your prenatal appointments, but also follow the advice of your obstetrician. For example, if they say you should be on bed rest, follow their instructions. On the opposite note, do not put yourself on bed rest without asking your doctor as this may have negative side effects.
3. Eat a healthy diet: Healthy weight gain during a multifetal pregnancy is a possible way to help ensure the healthy weight gain of your babies. Your diet should include plenty of protein, as well as the appropriate vitamins and minerals.
4. Drink lots of water: Staying hydrated is important for every person, not just expectant moms. But, if you are having twins, be sure to drink water often. Dehydration may spur premature birth.
5. Understand the signs of premature labor: Because premature birth is more common in twin pregnancies, you will need to listen to your body. Be familiar with anything out of the ordinary, even if it seems okay for singleton pregnancies. The goal will be to ensure your twins can grow inside your womb as long as gestation is still healthy.

Are you looking forward to having twins?

Congratulations! Your life will be forever changed by the joy of experiencing this unique type of parenthood! The team here at Women’s Healthcare Associates is here for you every step of your pregnancy and beyond. You can reach us at (806) 355-6330 to learn more about our services.